Transfers are the highest-risk activities in stroke home care. An incorrect transfer can cause shoulder subluxation, falls, or caregiver injury. The right technique is not optional — it is patient safety.

Section 01

Transfer Principles That Never Change

  • Non-slip footwear first: Always before any standing or transfer. Never allow a stroke survivor to stand in socks.
  • Dangle before standing: Sit upright at the edge for 30–60 seconds before standing. Orthostatic hypotension — blood pressure drop on rising — causes dizziness and falls.
  • Use a gait belt: Around the waist for any unsteady client. Never pull by the arm.
  • Narrate every step: "I am going to help you stand now — on three, one, two, three." This recruits the client's participation and reduces the element of surprise.
  • Transfer toward the stronger side: Provides more active participation from the client.
Section 02

Bed to Chair Transfer

1

Position the chair

At 45 degrees to the bed on the client's stronger side. Lock wheelchair brakes. Footrests up or removed.

2

Bring to sitting

Help client to sitting at edge of bed. Support the affected arm — do not let it hang. Dangle 30–60 seconds. Both feet flat on the floor.

3

Assist to standing

With gait belt in place, count to three and assist to standing. They push up with their strong arm. Guide and support — do not pull them up.

4

Pivot and lower

Pivot toward the chair (toward stronger side), ensure backs of legs touch the seat, guide to sitting. Affected arm supported throughout.

Section 03

Walking Assistance

  • Walk on the affected side: Position yourself on the client's weaker side to provide stability.
  • Gait belt for unsteady walkers: Keep your hand on the belt, not on the arm or shoulder.
  • Clear the path first: Check the route before walking.
  • Watch for foot drop: The foot cannot be lifted properly during walking — creates tripping risk. Report to nurse; an AFO may be prescribed.
Section 04

If a Client Begins to Fall

🚨 Guide a fall — never try to catch it
Your instinct to catch a falling client can injure both of you. The correct response: use the gait belt to guide them to the floor safely. Step back slightly, keep your back straight, guide them down under control. Then: assess for injury, call for help if needed, do not attempt to get them up alone. Attempting to lift a fallen person alone is a leading cause of caregiver injury.
Section 05

Positioning at Rest

✓ Proper positioning prevents complications
  • In bed: follow the therapist's positioning protocol. Affected arm supported on a pillow, shoulder in slight forward position. Avoid lying on the affected side for prolonged periods.
  • In a chair: affected arm on armrest or pillow. Foot flat on floor or footrest. Upright at 90 degrees.
  • Reposition every 2 hours: stroke survivors with limited movement are at high pressure sore risk.
Knowledge Check

Lesson 2 Quiz

5 questions · Passing score: 80%
Question 1
When performing a bed-to-chair transfer, toward which side should you ideally pivot?
Question 2
A stroke survivor begins to lose balance while walking with you. You have a gait belt. You should:
Question 3
Foot drop after stroke creates a specific risk of:
Question 4
When walking alongside a stroke survivor with left-sided weakness, you should position yourself:
Question 5
A stroke survivor has been sitting in a wheelchair for 3 hours. You should: